For people with type 2 diabetes, low blood sugar (hypoglycemia) can
come on suddenly and strong. Even if you’re well-versed in symptoms such as
shaking, dizziness, and headache, you might not have time to get back home or
to a store if you're without glucose tablets or food to treat low blood sugar.

A study published in the June 2013 issue of Endocrinology
Practice found that about 17 percent of those with type 2 diabetes and 28 percent of the people
with type 1 diabetes reported hypoglycemia symptoms in the preceding six months.
Those who had low blood sugar events also experienced a lower quality of life. Yet
despite how common hypoglycemia is, many people with diabetes still don’t plan
for this risk.

Hypoglycemia
Can Happen at Any Time

“I always ask people with diabetes, ‘Do you have something with
you in case your blood sugar gets low?’ Oftentimes, they say no,” says Karen A. Chalmers, MS, RD, CDE, a certified
diabetes educator and the diabetes services
program manager in the section of endocrinology, diabetes, and nutrition at
Boston Medical Center in Massachusetts. She's known people who’ve felt symptoms
of low blood sugar coming on while running errands, thought they could get to a
nearby store to buy juice or food quickly, and collapsed on the sidewalk before
they made it there. She's also known people whose hypoglycemia symptoms include
cognitive impairment, leaving them passed out in front of a refrigerator because
they were too confused to reach for the juice inside.

Hypoglycemia is not to be taken lightly. Most people with
diabetes are so focused on controlling high blood sugar that the possibility of
low blood sugar doesn’t cross their minds. Those most at risk for hypoglycemia
are people who take insulin, but some other diabetes medications also have low
blood sugar as a possible side effect. It’s important to ask your doctor if low
blood sugar is a concern for you.

Recognizing Low
Blood Sugar

The
first step, says Chalmers, is to know what low blood sugar is and when your
blood sugar is too low, which you can measure with a glucose test. If your blood
sugar is 70 mg/dL or below, you have low blood sugar that requires an immediate
response. If your blood sugar is approaching that level — 77 mg/dL,
for example — you need to make a quick plan because you don’t know if
your blood sugar is going down or up.

It’s
important to have these numbers as a reference, she says, because some people
with diabetes, especially those who have had very high blood sugar for a long
time, worry unnecessarily about low blood sugar well before their numbers ever
get that low.

However,
some people have what's called hypoglycemia unawareness, which means that they
don't feel any symptoms. This is dangerous because, without warning, they might
pass out or have seizures from hypoglycemia in unsafe or dangerous situations.
This is less common in people with type 2 diabetes than it is in those with
type 1 diabetes. Research suggests that people with hypoglycemia unawareness
can become aware of low blood sugar by avoiding frequent lows. Talk to your
doctor if this is the case for you.

The Rule of 15

When
your blood sugar is 70 mg/dL or lower, use the American Diabetes Association’s
“rule of 15:” treat with 15 grams of carbohydrates and check your blood sugar
in 15 minutes. If your blood sugar is still below 70 mg/dL after 15 minutes,
take another 15 grams of carbohydrates, and check your blood sugar again in another
15 minutes. Repeat as needed until your blood sugar is back to your target
range.

“The best option
to treat low blood sugar is glucose tablets,” Chalmers says. “They are pure
glucose specifically designed for hypoglycemia.” Since each tablet contains
about 4 grams of carbohydrates, you’ll need to anticipate taking at least four
tablets. Another option is glucose gel, which can be squeezed into your mouth
and rubbed on your gums if necessary.

You
can also carry pre-packaged snacks that satisfy the rule of 15, which means
they deliver the needed 15 grams of carbs in a way that can raise blood sugar
quickly enough. These include:

4 ounces of
juice (apple or orange)

4 ounces of
regular soda

1
tablespoon of frosting

3 hard
candies

When
choosing emergency options, think about what's easiest for you to keep handy at
all times. Hard candies, glucose tablets, and glucose gel are probably your
best bet if you want items that are small, portable, and easy to use, although
kid-sized juice boxes or pouches might work, too. Also, all of these items are easy
to keep in your nightstand in case you have low blood sugar at night.

One
food to skip when you have low blood sugar, however, is chocolate. The fat in
chocolate slows down your body’s use of its carbs, which means it can’t give
you the carb boost you need for hypoglycemia control.

Hypoglycemia
Safety

Even if you carry your 15 grams on you, it’s still possible to
have a hypoglycemia episode so sudden that you can’t respond. To be prepared
for this possibility, you should:

Wear a
medic alert bracelet. Contemporary jewelry designs offer attractive
options that still give health providers and first responders the
information they need to help you.

Program an “in
case of emergency” (ICE) number into your phone. This is the person who
must be called if you collapse or pass out.

Let people
around you know you may be at risk for hypoglycemia. Family members,
friends, co-workers, and close neighbors should be aware and check on you
if they haven’t seen you in awhile. It's especially important for people with
diabetes who live alone to make sure someone knows about their risk.

Have
glucagon nearby at work and at home if low blood sugar is a serious
concern. This is a powder that can be mixed with water and given as an
injection to quickly raise blood sugar levels. Someone close to you will need
to be trained on how to use glucagon should you become unconscious.

Once you’ve recovered from a low blood sugar episode, the most
important step is to figure out why it happened, Chalmers says. Think about the
course of events that led up to it: Did you take insulin but not eat? Did you
work out and fail to test and make sure your blood sugar was staying in a
healthy range? Did you go too long without food? Did you push yourself too hard
when you knew you had no rescue foods around? Learn from the experience so you
can avoid or respond better to the next episode — or prevent it in
the first place.

This site complies with the HONcode standard for trustworthy health information:verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.